Group analyzes Maine health care spending

AUGUSTA, Maine — Health care was in the spotlight on Friday as state officials and others seeking to improve Maine’s health care system reviewed three revealing reports.

— According to data from 2006, Mainers sought care in hospital emergency departments at a rate 30 percent higher than the national average.

— The same year, potentially avoidable hospital admissions ramped up health care spending in the state by more than $283 million.

— In 2005, Maine’s Medicaid program and public employee groups such as state workers, municipal employees, University of Maine employees and public school teachers spent nearly $3 billion to care for just over 500,000 people — the cost driven largely by increased use of outpatient services such as high-tech imaging and cancer screenings.

The three reports were presented to the Advisory Council on Health Systems Development, a study group established by Gov. John Baldacci’s 2003 Dirigo Health Reforms and representing health care, the insurance industry, policymakers and consumers. The advisory group is charged with making annual policy recommendations to the Legislature.

According to the emergency care utilization study conducted by the Muskie School of Public Service and funded by the Maine Health Access Foundation, Maine’s total emergency department use in 2006 was 30 percent higher than the national average. Use of emergency department services was three times higher among Mainers enrolled in MaineCare, the state’s Medicaid program, than among those with private health care insurance. Patients with no health care coverage accounted for 9 percent of emergency department visits.

The most common reason for seeking emergency department care was pharyngitis, or a sore throat, followed by upper respiratory infections, including the common cold and sinus infections.

“A substantial number of visits are made for conditions that could be appropriately treated in office or clinic settings,” the report states.

Geographically, rates of emergency department use varied substantially, from a high of 47 percent of the population served by Sebasticook Valley Hospital in Pittsfield to a low of 17 percent of the population served by the York Hospital. Study authors noted that regional differences in emergency department use are affected by a complex mix of factors, including MaineCare enrollment rates, availability of primary care practices and clinics, average age of population, and income and education levels.

A study by the private Health Dialog organization in Portland found that increased use of health care services, rather than increases in the cost of those services, is the primary driver of health care spending. Use accounts for 65 percent of spending while price increases account for only 35 percent, according to the study report.

Approximately $283.6 million in inpatient spending could be avoided by improving the quality of primary and specialty care, especially in managing chronic conditions such as lung disease, heart disease and diabetes so patients don’t need to be hospitalized so often, according to the report.

Spending on preventable outpatient laboratory tests, X-rays, and other services could be cut by as much as $304.8 million by improving the quality of care.

Public health care purchasers, including state employee groups and the MaineCare program, have instituted a number of measures aimed at improving the care their members receive, according to the report of the Public Purchasers Steering Group. Public employees who seek care from “blue ribbon providers” identified by the Maine Health Management Coalition, for example, are not responsible for co-payments. Participation in a special two-year diabetes management program can eliminate out-of-pocket spending on glucose testing strips, insulin syringes and other supplies.

But efforts to reduce costs by merging administrative functions or standardizing coverage have met with resistance, according to the report.

“While each entity clearly relies on public dollars to pay for health care premiums and-or services, there are very significant differences between organizations with regard to employee demographics, labor arrangements and consequently, benefit priorities and practices,” the report states. While the separate groups have adopted changes that benefit their respective members, finding common ground can prove elusive, according to the report.

Also elusive at the meeting were specific recommendations for reducing Maine’s health care spending. The Health Dialog report suggests some short-term strategies, including providing financial incentives for primary care providers who expand their hours of service, regulating quality-of-care reporting, and supporting public health policies that improve wellness and reduce the incidence of chronic disease.

Trish Riley, director of the governor’s Office of Health Policy and Finance, said the advisory group would present its own recommendations to the Legislature at the end of March. The reports are available online at www.maine.gov/gohpf.